Promoting Action on Research Implementation in Health Services framework applied to TeamSTEPPS implementation in small rural hospitals

Communities catalyzing change with data to mitigate an invisible menace, traffic-related air pollution

OBJECTIVES

To identify strategies and tactics communities use to translate research into environmental health action.

METHODS

We employed a qualitative case study design to explore public health action conducted by residents, organizers, and public health planners in two Massachusetts communities as part of a community based participatory (CBPR) research study. Data sources included key informant interviews (n = 24), reports and direct observation of research and community meetings (n = 10) and project meeting minutes from 2016-2021. Data were coded deductively drawing on the community organizing and implementation frameworks.

RESULTS

In Boston Chinatown, partners drew broad participation from community-based organizations, residents, and municipal leaders, which resulted in air pollution mitigation efforts being embedded in the master planning process. In Somerville, partners focused on change at multiple levels, developer behavior, and separate from the funded research, local legislative efforts, and litigation.

CONCLUSIONS

CBPR affords communities the ability to environmental health efforts in a way that is locally meaningful, leveraging their respective strengths. External facilitation can support the continuity and sustainment of community led CBPR efforts.

Improving Access to Safe Water in Rural Schools of Kenya: Qualitative Multisectoral Insights

BACKGROUND

Comprehensive strategies in water, sanitation, and appropriate hygiene behaviors can improve school enrolment and improve gender parity disparities. Lack of safe drinking water negatively impacts the social capital of people, especially school-going children in rural areas. In this study, we systematically evaluated and documented evidence on the barriers and facilitators in the access and adoption of safe water practices in rural schools in Laikipia County, Kenya.

METHODS

An ethnographic formative, collaborative implementation research design was used in an iterative and participatory process to evaluate community, socio-economic, and health system-related factors affecting water, hygiene, and sanitation strategies. Qualitative data was collected using key informant interviews (n=5) and focus groups (n=3) from various multisectoral participants. Directed content analysis was used to develop codes, categories, and themes from textual data. Data was organized according to the Promoting Action on Research Implementation in Health Services framework.

RESULTS

The findings were classified and described under three key elements: context, evidence, and facilitation. Contextual elements showed an association of diarrhea outbreaks with unsafe hygiene practices compounded by water scarcity. The evidence elements were indicative of the applicability of water backpacks in strengthening handwashing, storage, and transport of water. Facilitation elements indicated evidence of gaps in synergy between the school health and public health systems, necessitating multisectoral collaboration and social capital capacity building.

CONCLUSION

The national and county governments play an imperative role in ensuring access and continuous supply of safe drinking water in schools. This is fundamental in efforts towards reducing social inequalities of health among school-going children and building their social capital. Participatory, collaborative, multisectoral interventions and decision-making are crucial, leveraging on creating local ownership, in meeting the water consumption needs of children and communities in water-scarce regions.

The Link between HRM Practices and Performance in Healthcare: The Mediating Role of the Organizational Change Process

The role of human resources as a change agent in the organizational change process holds great importance. Hence, it is crucial to identify ways human resources can support change. This paper investigates the direct and indirect relationships between human resource management (HRM) practices and organizational performance, as well as the mediating role of the organizational change process in these relationships. The proposed model integrates primary HRM practices, organizational change components, organizational performance, employee retention, and organizational abandonment. We collected data to evaluate the relationships between the model variables through a survey questionnaire applied to 441 Romanian employees in the healthcare industry. The paper used structural equation modeling to test the model's validity and hypotheses. The results show that HRM practices directly impact organizational performance and have a mediated impact through the organizational change process. Additionally, the direct and mediating effects are consistent, and healthcare employers consider appropriate HRM practices and effective management of the organizational change process as essential drivers to achieve superior performance. The empirical findings provide valuable insights for government policymakers, stakeholders, and health managers on how suitable HRM practices can influence organizational performance.

The impact of knowledge brokering in health sector and the challenges: A review of literature

Knowledge brokering is a type of knowledge translation that bridge the researchers and end users. Knowledge brokering assist the interactions between all agents to understand each other's perspectives and goals to improve health system performance. The failure to deliver how important the research implementation in society may cause significant outcome. A person or organization who perform knowledge brokering is called knowledge broker (KB). Literature review is conducted for the clinical question of how knowledge brokering impact the health sector and the visible challenges. A literature search is performed by systematic search using three major online databases; Cochrane, PubMed, and EBSCO. Hand-searching also yielded one result that fit the objective of this study. The database result search was being screened from the title and abstract which resulted in 14 relevant articles. After reading the full-text articles, four literatures were ruled-in. The study assessed knowledge brokering process using various methods like single framework or model as well as the combination. The challenges include the lack of communication between internal team and end users, leadership skill, engaging end users, knowledge transfer activity, different timeline, and diverse vision. Evaluating and applying knowledge brokering strategies were needed as the practice itself bringing positive outcomes. Knowledge brokering approaches consist of many methods which tailored to the study objective. Challenges that stand out were communication and personal skill, engaging end users, and perspectives difference. The impact of knowledge brokering is challenging to assess. Further studies that evaluate the impacts of knowledge brokering are still needed.

Conceptual and relational advances of the PARIHS and i-PARIHS frameworks over the last decade: a critical interpretive synthesis

BACKGROUND

The number of research publications reporting the use of the Promoting Action on Research Implementation in Health Services (PARIHS) framework and the integrated PARIHS (i-PARIHS) framework has grown steadily. We asked how the last decade of implementation research, predicated on the (i-)PARIHS framework (referring to the PARIHS or i-PARIHS framework), has contributed to our understanding of the conceptualizations of, relationships between, and dynamics among the core framework elements/sub-elements. Building on the Helfrich et al. (2010) review of research on the PARIHS framework, we undertook a critical interpretive synthesis to: (1) identify conceptual and relational advances in the (i-)PARIHS framework and (2) identify conceptual and relational aspects of the (i-)PARIHS framework that warrant further work.

METHODS

We performed a systematic search in PubMed/PubMed Central, Ovid MEDLINE, CINAHL, JSTOR, SCOPUS, Web of Science, and PsycInfo. Articles were eligible for synthesis if they (a) were peer-reviewed articles, written in English, and published between January 2009 and December 2021, (b) applied the (i-)PARIHS framework explicitly to guide implementation research, and (c) made conceptual (expanding the conceptualization of core elements) and/or relational contributions (elaborating relationships among elements/sub-elements, or theorizing the relationships using empirical data). We used a critical interpretive synthesis approach to synthesize conceptual-relational advances of the (i-)PARIHS framework.

RESULTS

Thirty-seven articles were eligible for synthesis. Twenty-four offered conceptual contributions, and 18 offered relational contributions (5 articles contributed in both ways). We found conceptual expansion of all core (i-)PARIHS elements, with most emphasis on context (particularly outer context and leadership), facilitation, and implementation success. Articles also gave insights into the complex relationships and relational dynamism among these elements, characterized as contingent, interactive, multilevel, and temporal effects.

CONCLUSIONS

We observed developmental advances of the (i-)PARIHS framework and proposed several directions to further advance the framework. Conceptualization of (i-)PARIHS elements (particularly evidence/innovation and recipients) need to be further developed by specifying conceptual and operational definitions of underlying sub-elements. Relationships among (i-)PARIHS elements/sub-elements need to be further elaborated through empirical studies that consider situational contingencies and causal complexities. This will require examining necessity and sufficiency of (i-)PARIHS elements/sub-elements in relation to implementation outcomes, interactions among elements, and mechanism-based explanations.

A knowledge implementation model in health system management based on the PARIHS model

BACKGROUND

The gap between knowledge and practice, along with postponing or not implementing research findings in practice and policy-making, is one of the reasons for low-quality services. Hence, this study aimed at presenting a model of knowledge implementation in health system management in Iran.

METHODS

The present two-phase study was first performed qualitatively using a directive content analysis approach based on the Promoting Action on Research Implementation in Health Services (PARIHS) model. The researchers extracted the barriers and facilitators by conducting semi-structured individual interviews. Then, in a three-stage Delphi study, 25 health experts determined the barrier removal strategies. Data were analysed using MAXQDA10 software.

RESULTS

 The content analysis of the interviews led to the emergence of 1212 codes under three categories of evidence, context and facilitation. The findings indicate that health managers make fewer decisions based on research findings. Instead, they make decisions regarding the experiences of service providers and organization data. In addition to the subcategories in the PARIHS model, the researchers extracted political, social and administrative factors under the context category. The relationships between the features of evidence, context, facilitation, barriers and strategies were presented in the final model.

CONCLUSION

 The presented model comprehensively emphasizes the evidence resources, context preparation, and facilitation of the knowledge implementation process.

Benefits and concerns associated with blockchain-based health information exchange (HIE): a qualitative study from physicians' perspectives

BACKGROUND

Blockchain technology has the potential to revolutionize information sharing in companies. Many studies suggest using blockchain-powered platforms to replace existing mechanisms for health information exchange (HIE) across healthcare organizations. However, very few blockchain-based projects have been implemented in the healthcare sector. This study takes a qualitative approach to explore benefits, concerns, and barriers to the rollout of blockchain in HIE projects from physicians' perspectives.

METHODS

The Promoting Action on Research Implementation in Health Services (PARIHS) framework was used to help us better understand root causes, existing problems, perceived risks, perceived benefits, and suggestions. In-depth interviews have been conducted with 38 physicians in six months. The data were analyzed and coded using NVIVO to classify conceptually similar themes mentioned by the interviewees.

RESULTS

In total, seven themes have been identified. The key benefits are categorized into three themes: innovative technological features, collaborative ecosystem, and system performance. The main concerns and risks are categorized into four themes: individual, organizational, technological, and market-related issues. The findings can contribute to knowledge by highlighting key values expected from blockchain technology in HIEs. The results also explore obstacles to leveraging the blockchain in healthcare from the perspectives of an important stakeholder (physicians).

CONCLUSIONS

The results show that although blockchain technology may create several benefits (e.g., innovative technological features, collaborative ecosystem, and system performance), its applications in healthcare are still in their early stages. The perceptions of the individual issues (e.g., lack of knowledge), organizational issues (e.g., implementation issues), technological issues (e.g., blockchain model types), and market-related issues (e.g., regulatory concerns) indicate that blockchain-based applications in healthcare continue to be an emerging field. This study has practical implications as understanding these concerns can help developers and healthcare managers identify potential issues in the planning, developing, and implementing blockchain-based HIE systems. Addressing these barriers would support the widespread use of blockchain-based HIEs in different healthcare settings and facilitate interoperability and connectivity in regional and community health information networks.

Implementation Science of Paediatric Palliative Care in Lower-Middle-Income Countries in Southeast Asia: An Integrative Review

There is an ongoing development in the paediatric palliative care (PPC) program in Southeast Asia (SEA). However, the implementation process has not been clearly understood among lower-middle-income countries (LMICs) in this region. The purpose of this paper is to review and synthesise research about the implementation process of 7 identified LMICs in the SEA: Cambodia, Indonesia, Myanmar, Lao PDR, the Philippines, Timor-Leste, and Vietnam. An integrative review utilising Whittemore and Knafi’s five-stage process was employed. Electronic searches of CINAHL, Web of Science, ProQuest, and Google Scholar (no year restriction) were conducted. From the 7599 articles retrieved, only 11 met the eligibility criteria. Each article was appraised for methodological quality (QualSyst tool and AACODS checklist) and constant comparison methods were used. Two overarching themes emerged in this review - the gaps in PPC standards, practice framework, and guidelines and the PPC challenges and implementation strategies. Understanding the implementation science of PPC among LMICs in the SEA region addresses the gap between idealism and realism. It provides reliable information in the development of strategic work plans that will improve the implementation process and promote the translation of EBIs into practice significant to the quality of paediatric patient outcomes.

Impact of TeamSTEPPS Training With Rural Hospital Staff: A Quality Improvement Project

BACKGROUND

Teamwork and communication are critical components to patient safety and reducing clinical errors. TeamSTEPPS is a successful team-training program evaluated by many health care settings; however, there are limited data on its use in small, rural hospitals.

LOCAL PROBLEM

A large health care system purchased a small, rural hospital with the goal to improve patient care by creating a team-based culture and a financially stable organization.

METHODS

This quality improvement project used a pre-/postdesign to evaluate the staff's knowledge, application, and attitudes toward team skills and behaviors.

INTERVENTION

The intervention was a customized TeamSTEPPS training program delivered to an interprofessional team at a small rural hospital.

RESULTS

The interprofessional staff demonstrated improved attitudes toward team behaviors and incorporated the tools into their practice.

CONCLUSIONS

TeamSTEPPS is an effective program for training a variety of health care disciplines.

The Key Role of Strategically and People-Oriented HRM in Hospitals in Slovakia in the Context of Their Organizational Performance

The main objective and purpose of our paper is to verify the positive congruence between the synergistic effect of the mixed roles of human resources management departments in healthcare facilities and their organizational performance. Such congruence is mediated by means of a transformational leadership style and information sharing. The research was carried out on a sample of 44 hospitals in the Slovak Republic, which are included in the ranking according to a comprehensive indicator of their performance (medical and non-medical). Data were obtained using a questionnaire for 44 top managers from these hospitals. Mediation was used as a tool to examine the relevant variables relationship mechanism. All data was analyzed using the SPSS 24.0 software package with the help of selected analytical tools. A series of regression analysis were used to identify the proposed hypotheses. ANOVA was used to analyze the multiple dependence. We worked at a significance level of 5%. The main conclusion of our study is the significant impact of the implementation of the new-mixed role of human resources management departments on organizational performance. Another finding is that the direct effect between the two variables examined is more significant than the mediated effect. This means that if management unambiguously declares and implements the policy of mixed roles of human resources management departments, less influence from the mediator-transformational leadership is sufficient to transmit the effect of this variable onto organizational performance. Completed specialization studies in the field of management play a significant role in the studied relationships.

The use of the PARIHS framework in implementation research and practice-a citation analysis of the literature

BACKGROUND

The Promoting Action on Research Implementation in Health Services (PARIHS) framework was developed two decades ago and conceptualizes successful implementation (SI) as a function (f) of the evidence (E) nature and type, context (C) quality, and the facilitation (F), [SI = f (E,C,F)]. Despite a growing number of citations of theoretical frameworks including PARIHS, details of how theoretical frameworks are used remains largely unknown. This review aimed to enhance the understanding of the breadth and depth of the use of the PARIHS framework.

METHODS

This citation analysis commenced from four core articles representing the key stages of the framework's development. The citation search was performed in Web of Science and Scopus. After exclusion, we undertook an initial assessment aimed to identify articles using PARIHS and not only referencing any of the core articles. To assess this, all articles were read in full. Further data extraction included capturing information about where (country/countries and setting/s) PARIHS had been used, as well as categorizing how the framework was applied. Also, strengths and weaknesses, as well as efforts to validate the framework, were explored in detail.

RESULTS

The citation search yielded 1613 articles. After applying exclusion criteria, 1475 articles were read in full, and the initial assessment yielded a total of 367 articles reported to have used the PARIHS framework. These articles were included for data extraction. The framework had been used in a variety of settings and in both high-, middle-, and low-income countries. With regard to types of use, 32% used PARIHS in planning and delivering an intervention, 50% in data analysis, 55% in the evaluation of study findings, and/or 37% in any other way. Further analysis showed that its actual application was frequently partial and generally not well elaborated.

CONCLUSIONS

In line with previous citation analysis of the use of theoretical frameworks in implementation science, we also found a rather superficial description of the use of PARIHS. Thus, we propose the development and adoption of reporting guidelines on how framework(s) are used in implementation studies, with the expectation that this will enhance the maturity of implementation science.

Revealing tacit knowledge used by experienced health professionals for interprofessional collaboration

With the current interest in interprofessional collaboration in health care as a response to ever-increasing complexity of health issues and scarcity of resources, many higher education institutions are developing interprofessional education (IPE) programs. However, there has been little empirical work on what. With the current interest for interprofessional collaboration in health care ever-increasing knowledge and skills are required to work collaboratively between health professions. We have undertaken to describe interprofessional collaboration as a practice largely underpinned by tacit knowledge acquired by experienced clinicians. Clinicians from all health professions in a large francophone university in Eastern Canada were invited to participate in explicitation interviews. Explicitation interviews require participants to freely recall an interprofessional collaboration event (e.g., team meeting or joint care delivery) and describe specific actions they personally enacted. An experienced health professional encounters many interprofessional situations over time; the actions they describe reflect their personal theories about the practice. Hence, it is highly probable that they use them frequently when working with colleagues in clinical settings. Unveiled tacit knowledge was divided into four themes: the importance of a sense of belonging to a team, the imperative to meet face-to-face, the practice of soliciting the working hypotheses of colleagues, and the art of summarizing meeting discussions.

Patient safety from executive hospital management to wards: A qualitative study identifying factors influencing implementation

AIM

To examine the journey of safety initiatives from executive hospital management to ward.

BACKGROUND

Hospital management teams are often responsible for identifying safety priorities and ensuring delivery of these.

METHOD

Naturalistic study design within a large NHS Hospital Trust. Using semi-structured interviews, focus groups and secondary data analysis, the study examines the implementation of safety initiatives.

RESULTS

While hospital management developed five safety initiatives, only one of these (falls prevention) was actually seen to permeate all layers of the organisation. Other initiatives stopped one layer down. Both middle management and ward staff added to the list of initiatives developed, resulting in 16 priorities. A range of positive and negative influences to successful implementation are identified.

CONCLUSIONS

Safety initiatives need positive reinforcement at all levels to be addressed appropriately. The research suggests that a model related to improvement science may prove useful in ensuring that priorities are addressed.

IMPLICATIONS FOR NURSING MANAGEMENT

Care should be taken to ensure that safety initiatives are successfully implemented at all levels within an organisation. Identifying priorities with staff and sharing values and priorities are a key approach to leading such initiatives.

Knowledge implementation in health care management: a qualitative study

Background

The gap between knowledge and practice is a global issue, which increases wasteful spending in healthcare. There are several models and frameworks to address this gap and try to solve the challenge. Promoting Action on Research Implementation in Health Services (PARIHS) framework highlights the interaction of three main elements: evidence, context and facilitation, to implement research into practice, successfully. This framework can use as a tool to evaluate the situation and guide the changing. This study conducted to explain the status of knowledge implementation in Iran’s healthcare management system.

Methods

This qualitative study was done by using a directive content analysis approach through conducting in-depth, structured interviews with 15 health managers based on the PARIHS framework. Guiding questions were based on the three main elements of the framework: evidence, context and facilitation. The content of the interviews entered into the Qualitative Data Analysis software (MAXQDA version 10) and, then, analyzed.

Results

The most common source of evidence used by managers for decision-making was local information and previous experience. Evaluation more emphasized compared to other sub-elements of context, i.e. culture and leadership. In terms of facilitation, performing tasks by others was the dominant opinion.

Conclusion

Our results showed that managers in the healthcare system of Iran use their own and other manager’s experience and the local information for decision-making and have no ideas about facilitation.

Videoconferencing Psychotherapy in the Public Sector: Synthesis and Model for Implementation

BACKGROUND

Videoconferencing psychotherapy (VCP) is a growing practice among mental health professionals. Early adopters have predominantly been in private practice settings, and more recent adoption has occurred in larger organizations, such as the military. The implementation of VCP into larger health service providers in the public sector is an important step in reaching and helping vulnerable and at-risk individuals; however, several additional implementation challenges exist for public sector organizations.

OBJECTIVE

The aim of this study was to offer an implementation model for effectively introducing VCP into public sector organizations. This model will also provide practical guidelines for planning and executing an embedded service trial to assess the effectiveness of the VCP modality once implemented.

METHODS

An iterative search strategy was employed, drawing on multiple fields of research across mental health, information technology, and organizational psychology. Previous VCP implementation papers were considered in detail to provide a synthesis of the barriers, facilitators, and lessons learned from the implementation attempts in the military and other public sector settings.

RESULTS

A model was formulated, which draws on change management for technology integration and considers the specific needs for VCP integration in larger organizations. A total of 6 phases were formulated and were further broken down into practical and measurable steps. The model explicitly considers the barriers often encountered in large organizational settings and suggests steps to increase facilitating factors.

CONCLUSIONS

Although the model proposed is time and resource intensive, it draws on a comprehensive understanding of larger organizational needs and the unique challenge that the introduction of VCP presents to such organizations.

Effect of An Evidence-Based Nursing Intervention on the Diagnosis of Oral Mucositis in the Pediatric Stem Cell Transplant Unit

Objective:

This quasi-experimental, single-group study with a pre- and post-repeated measures design was carried out at the Pediatric Stem Cell Transplant Unit of a University Hospital. The study was aimed at investigating the effect of an evidence-based nursing intervention program, held for nurses providing care for pediatric stem cell transplant patients, on their skills in diagnosing oral mucositis (OM).

Methods:

Before training, data were collected from all the nurses using a sociodemographic characteristics questionnaire. Six patients who were admitted to the clinic and started chemotherapy (CT) were followed up for a maximum of 1 month during their hospitalization to find whether the diagnosis of OM was performed. During the intervention stage, the researcher provided nurses with training on the importance of the use of evidence-based research results in the clinic, including evidence regarding OM. After the training, the records of six patients who were admitted to the clinic and started CT were tracked for up to 1 month during their hospitalization to find whether the diagnosis of OM was performed.

Results:

At the end of the study, the rate of OM diagnosis was performed by nurses, which was 2.8% before the program and increased to 8.7% after the program. The difference between the percentages of performing OM diagnosis by the nurses before and after the program was 5.9%, which was considered statistically significant (χ² = 11.004, P < 0.01). The postprogram rate of diagnosis of OM was 3.12 times higher (212% increase) than the preprogram rate (P < 0.01).

Conclusions:

One of the most important recommendations of the present study is to provide regular and continuous training sessions for nurses to improve and update their knowledge on oral care. It is also concluded that the establishment of oral diagnosis as a follow-up parameter, similar to vital signs in the clinic, will enable nurses to improve their skills in performing daily diagnosis and keeping proper records of the patients’ outcomes.

Key Issues in the Development of an Evidence-Based Stratified Surgical Patient Safety Improvement Information System: Experience From a Multicenter Surgical Safety Program

Surgery is still far from being completely safe and reliable. Surgical safety has, therefore, been the focus of considerable attention over the last few decades, and there are a growing number of national drives to improve it. There are also a number of large surgical complication reporting systems and system-based interventions, both of which have made remarkable progress in the past two decades. These systems, however, have either mainly focused on reporting complications and played a limited role in guiding practice or have provided nonselective interventions to all patients, perhaps imposing unnecessary burdens on frontline medical staff. We have, therefore, developed an evidence-based stratified surgical safety information system based on a multicenter surgical safety improvement program. This study discusses some critical issues in the process of developing this information system, including (1) decisions about data gathering, (2) establishing and sharing knowledge, (3) developing functions for the system, (4) system implementation, and (5) evaluation and continuous improvement. Using examples drawn from the surgical safety improvement program, we have shown how this type of system can be fitted into day-to-day clinical practice and how it can guide medical practice by incorporating inherent patient-related risk and providing tailored interventions for patients with different levels of risk. We concluded that multidisciplinary collaboration, involving experts in health care (including senior staff in surgery, nursing, and anesthesia), data science, health care management, and health information technology, can help build an evidence-based stratified surgical patient safety improvement system. This can provide an information-intensified surgical safety learning platform and, therefore, benefit surgical patients by delivering tailored interventions and an integrated workflow.

Types of internal facilitation activities in hospitals implementing evidence-based interventions

BACKGROUND

Implementation models, frameworks, and theories recognize the importance of activities that facilitate implementation success. However, little is known about internal facilitation activities that hospital personnel engage in during implementation efforts.

PURPOSE

The aim of the study was to examine internal facilitation activities at 10 critical access hospitals in rural Iowa during their implementation of TeamSTEPPS, a patient safety intervention, and to identify characteristics that distinguish different types of facilitation activities.

METHODS

We followed 10 critical access hospitals for 2 years after the onset of implementation, conducting quarterly interviews with key informants. On the basis of the transcripts from the first two quarters, a coding template was developed using inductive analyses. The template was then applied deductively to code all interview transcripts. Using comparative analysis, we examined the characteristics that distinguish between the facilitation types.

RESULTS

We identified four types of facilitation activities-Leadership, Buy-in, Customization, and Accountability. Individuals and teams engaged in different types of facilitation activities, both in a planned and an ad hoc manner. These activities targeted at both people and practices and exhibited varying temporal patterns (start and peak time).

CONCLUSION

There are four types of facilitation activities that hospitals engage in while implementing evidence-based practices, offering a parsimonious way to characterize facilitation activities. New theoretical and empirical research opportunities are discussed.

PRACTICE IMPLICATIONS

Understanding the types of facilitation activities and their distinguishing characteristics can assist managers in planning and executing implementations of evidence-based interventions.

Team Training in the Perioperative Arena: A Methodology for Implementation and Auditing Behavior

Preventable medical errors in the operating room are most often caused by ineffective communication and suboptimal team dynamics. TeamSTEPPS is a government-funded, evidence-based program that provides tools and education to improve teamwork in medicine. The study hospital implemented TeamSTEPPS in the operating room and merged the program with a surgical safety checklist. Audits were performed to collect both quantitative and qualitative information on time out (brief) and debrief conversations, using a standardized audit tool. A total of 1610 audits over 6 months were performed by live auditors. Performance was sustained at desired levels or improved for all qualitative metrics using χ2 and linear regression analyses. Additionally, the absolute number of wrong site/side/person surgery and unintentionally retained foreign body counts decreased after TeamSTEPPS implementation.

Maximizing Team Performance: The Critical Role of the Nurse Leader

Facilitating team development is challenging, yet critical for ongoing improvement across healthcare settings. The purpose of this exemplary case study is to examine the role of nurse leaders in facilitating the development of a high-performing Change Team in implementing a patient safety initiative (TeamSTEPPs) using the Tuckman Model of Group Development as a guiding framework. The case study is the synthesis of 2.5 years of critical access hospital key informant interviews (n = 50). Critical juncture points related to team development and key nurse leader actions are analyzed, suggesting that nurse leaders are essential to maximize clinical teams' performance.